Head and Neck Cancer

The term head and neck cancer refers to a group of cancers found in the head and neck region. This includes tumors found in:

  • The oral cavity (mouth). The lips, the tongue, the teeth, the gums, the lining inside the lips and cheeks, the floor of the mouth (under the tongue), the roof of the mouth and the small area behind the wisdom teeth are all included in the oral cavity.
  • The oropharynx (which includes the back one-third of the tongue, the back of the throat and the tonsils).
  • Nasopharynx (which includes the area behind the nose).
  • Hypopharynx (lower part of the throat).
  • The larynx (voice box, located in front of the neck, in the region of the Adam’s apple). In the larynx, it can occur in any of the three regions: the glottis (the level of the vocal cords); the supraglottis (the area above the vocal cords); and the subglottis (the area that connects the glottis to the windpipe).

Oral cancer and cancer of the larynx are the most common forms of head and neck cancer. Almost half of all the head and neck cancers occur in the oral cavity, and a third of the cancers are found in the larynx. By definition, the term “head and neck cancers” usually excludes tumors that occur in the brain.

The primary risk factors for developing head and neck cancer are frequent use of alcohol, smoking and smokeless tobacco. Human papilloma virus (HPV) is another important risk factor. The incidence of HPV-associated oropharyngeal cancer has increased during the past 20 years, especially among men. It has been estimated that, by 2020, HPV will cause more oropharyngeal cancers than cervical cancers in the United States.

The signs and symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing, and a change or hoarseness in the voice. These symptoms may also be caused by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms.

Prevention of Head and Neck Cancer is best accomplished through limiting sun exposure, avoidance of tobacco use and copious consumption of alcohol. Routine dental exams and cleanings in conjunction with self-examinations are also recommended.

Additionally, the Food and Drug Administration has approved two vaccines to prevent HPV infection: Gardasil® and Cervarix®. Both vaccines are highly effective in preventing infections with HPV types 16 and 18. HPV-16 is an increasing cause of oropharyngeal cancer, a type of head and neck cancer (8). Researchers are studying the effects of HPV vaccination to see if it reduces the incidence of the types of HPV infection in the oral cavity that can lead to oropharyngeal head and neck cancers. More information on this topic is available in the NCI fact sheet Human Papillomavirus (HPV) Vaccines

Advances in Head and Neck Cancer treatment have provided patients with a variety of options. Primary treatment techniques include surgery (to remove the tumor), chemotherapy and radiation. The exact nature of treatment will depend on a multitude of factors including size, stage and site of the lesion as well as a variety of variables relating to each individual patient. It is crucial that patients work with a dedicated team of professionals (ENT, RN, Sp) to determine the optimal therapeutic regimen.

Surgical removal of head and neck tumors can have significant implications on speech, articulation, voice and swallowing. The exact nature of these deficits is directly related to the type of tumor. Similarly, chemotherapy and radiation can also have an impact on these functions as radiated tissue may become irritated, sore and stiff. It is crucial that patients work with an interdisciplinary team to ensure that all relevant preventative and supportive measures are employed. Specifically, patients should have direct access to a Speech Pathologist, Dietician, Social Worker and nurse. The speech pathologist will provide essential recommendations to help evaluate, manage and restore speech and swallowing function. The dietician will help ensure that the patient is receiving adequate nutrition by mouth or from a feeding tube. The role of the social worker is to provide essential support and resources to the patient and their families/caregivers. Finally, ongoing RN support will provide education and assistance in managing unpleasant side effects of the cancer treatment.

For more detailed information, please refer to the following websites with emphasis on Head and Neck Cancer:

www.spohnc.com

www.cancer.gov

www.nfosd.com

www.gbmc.org